The strategy is here to gradually expand the city sewerage network and improve sludge and waste water disposal with treatment. Expansion is generally done gradually, neighbourhood by neighbourhood, where expansion is physically, economically and financially viable. The connection priority goes to high risk neighbourhoods.
A first step to raise connections is to build on the awareness created by the general sanitation awareness campaign, but now to inform the households in targeted expansion neighbourhoods of the coming expansion, their options for connecting, the cost and benefits of connections and the implications of not connecting.
The situation that many locations will have a mix of better-off and poorer households will affect the awareness raising. The different positions and interests of men and women will also play a role. Men and women in better-off households are literate, so they can for example be informed through a house-to-house brochure or a letter. Brochures can also be spread at meetings where these two groups go to, e.g. religious meetings.
Poorer women and men have lower literacy levels and several and often different needs that will compete for the family expenditure. There is there fore a greater need to convince both to take a connection and invest in installing a sanitary toilet. A FGD strategy with women and men is more effective for convincing than mass media and methods such as TV and printed materials, especially when using participatory methods and materials.
Local planning choices
Sewerage connections (combined with waste waster disposal) can be made more affordable to poor households by offering them choices:
Households may take a connection to different models of toilet facilities, ranging from an outdoor pour-flush toilet in a free-standing or lean-to outhouse with a simple squatting plate and for the time being temporary walls, roofing and curtain, to an indoor, full-fledged flush toilet with porcelain wares for toilet, bathing and hand washing. Temporary materials can then be gradually replaced by permanent ones.
Households may share a single toilet and connection with a neighbour or neighbours. This may make it possible to install a higher class provision, e.g. a tiled toilet, without or with a shared bathing and/or laundry provision.
Where space allows, it may also be possible to build a household toilet block. This consists of two or four private toilets which share two or more walls by building side-by-side and/or back-to-back;.
Because women manage household sanitation and men decide on major household investments, couples will need to be invited through gender-appropriate channels to mixed FGDs in locations and at times suitable to both. Women and men can first sit in separate sub-groups if the local culture makes it easier for each category to express themselves and then the women’s group can explain their conclusions to the men’s and vice-versa. At the end of such meetings, the organizers (e.g. trained RT cadres) can begin taking the subscriptions to the various options (see also 22.214.171.124 below).
Poor household may find it hard to pay the connection fee as a lump sum. Some cities have set indicators for poor households and made connection to PDAM water free. The same policy of free connection for the poor can be followed for sewerage. An alternative is to make it not free, but charge a subsidized fee.
Indicators of poverty are locally-specific, so are best set locally. For this, local volunteers, e.g. the women’s and men’s religious groups or the local youth group carry out a participatory welfare classification and make a community map (see Section 6.3.1 below for the steps). They then mark the households with best, intermediate, worse and worst welfare in the map. Those falling in the worst category get a free or subsidized connection. The alternative is to use the national indicators for the very poor, as discussed under the poor-inclusive strategy.
To prevent misuse, a program in S. India used social control. The city councils plus local sanitation committees displayed the lists of selected households at various places in their communities. They then invited and investigated complaints from the public (Corruption in Sanitation - Water Integrity Network).
Another alternative is to allow poor households to pay the connection fee in stages as part of the regular tariff (see next section). The capital of Chile gives poor households the option to pay off the connection fee over a period of 12, 24 or 36 months, depending on city indicators (made by the city social service) of their level of poverty. In some cities in India, the sanitation program helps poor women set up saving clubs to pay off loans for toilets. According to the women, their husbands also contributed from their earnings.
Block connection households may be advised on how to share the block tariff, e.g. based on family size. The owners of the land have the advantage of having the toilet closest, so might be asked to pay a little more, but this is set off by the nuisance of sharing, so it is perhaps fairest when all pay the same. However, ultimately this depends on what the group members decide themselves.
To make sewerage and waste water disposal affordable to poor households, a social tariff (or tariffs in case of individual and block connections) can be set for low-income households, using the classification methods mentioned above. The same goes for sharing the tariff between block-users.
Most poor households do not have a bank account, so cannot pay electronically, unless payments are arranged through the saving clubs. (The situation may change when e-banking becomes linked to mobile phones). Making cash payments at the city office costs extra time and sometimes transport costs, especially when distances are far. The sewerage administration may in such cases consider asking the neighbourhoods to choose a tariff collector who collects the fees and pays the total to the municipality.
Having local tariff collectors makes it also possible to adjust the frequency of payment. Low-income households with varying incomes such as vendors and small shopkeepers may prefer to pay smaller amounts per week or even per day to a fellow female resident.
There are several reasons to encourage that RTs in cooperation with e.g. local women groups, select poor local women as money collectors:
Poor men can seek and find work outside their neighbourhoods; poor women need work in their own environment as culture and household tasks restrict their mobility. Such local job opportunities for them are limited;
Especially single poor women need paid work and find it very hard to find this in their own environment;
Women collectors visiting other women is culturally more appropriate;
Women collectors can, when trained, also do sanitation promotion and hygiene education to fellow-women;
Household payments are the domain of women; female collectors can follow up non-payments, find out reasons and be a source of knowledge for system improvements;
Because of their situation, poor women with no other sources of income are very committed to do a good job.
Making water and sewerage connections and installing toilets is generally a men’s job. There are, however, examples of cities which successfully trained, used and sometimes licensed local craftswomen for these tasks. EMOS, the municipal water and sewerage utility in the capital of Chile with 100% sanitation coverage has trained and licensed local women in poor areas to make and repair water and sewerage connections. They promote and repair connections among fellow women and charge them per job. The reasons for this strategy are the same as in the previous section.
Community Managed On-site Sanitation
Where technical, financial and/or poverty conditions make off-site solutions not (yet) possible, on-site group or community managed solutions are introduced. Gender mainstreaming aspects in these solutions are given per type of systems/services as listed in the sections below.
Individual household toilets
For on-site toilet choices both men and women need to be informed about what is technically and ecologically possible in their area, along with the potential designs and the pro’s and con’s of each option, their costs, and opportunities to reduce costs by using more or less expensive designs and expensive/durable materials.
Because decision making on toilet options is complex, it does not lend itself to a mass campaign, but is best done in group sessions. Men and women each have their own needs, responsibilities and knowledge related to toilet choice and their own reasons to install them, such as for men: status, value increase for the house, and providing good basic conditions and a clean environment for the family and for women: convenience, privacy, cleanliness, aesthetics, ease of operating (water collection!) and cleaning, and safety and usability for children.
It is therefore useful to start review sessions with a participatory demand assessment and increase activity. This is done in small group sessions in which a trained facilitator helps male and female household heads identify the chain of effects of having and using a sanitary toilet in mixed or, where culturally necessary, separate subgroups (Figure 3).
Having reach their conclusions on the needs and demands for any kind of sanitary toilet, the facilitator then helps them look at the toilet types possible and explains the pro’s and con’s, the costs and cost-reduction possibilities of each option and the possibilities for financing. Drawings or photos (preferable simple and low-costs so that local groups wishing to replicate the promotion can get their own sets) help visualise the choices.
Technical options for household toilets used by one (but sometime 2-3 families) include:
Direct single pit toilet (a soak pit directly under the squatting plate). Pour-flush or covered hole; Pour-flush may be without or with concrete slab with concrete or porcelain pan;
Single pit, off set, pour-flush toilet, without or with concrete slab with concrete or porcelain pan;
Double off-set toilet (one or two alternating soak pits behind the toilet) with (partial) slab and pan;
Eco-toilet (= toilet with two separate holes for urine and two for solid excreta, a separate hole over which the users wash themselves, and two above-ground alternating chambers. The urine is sterile and is directly taken off and is used as fertilizer (=pure nitrogen) mixed with water; the solid excreta are kept in the first chamber for 3-4 months. Thereafter they are fully composted, without smell and pleasant to handle and can be used and/or sold for growing ornamental plants, vegetables and fruit trees. Eco or dry toilets are especially suitable for areas with a high water table as they are build above the ground, and for areas where there is a demand for cheap yet good compost;
Water-flushed toilet with a septic tank or floating septic tank when the houses stand in water as in Banjarmasin). To be safe the tank must be sealed at the sides and bottom and on average be emptied say once per two years.
Those couples who decide which toilet they want to install can register with the agreed male and female leader(s); others may need more time and register with them later. When a sufficient number of registrations has been taken, acquisition of materials and construction can start.
Figure 3. Participatory Review of HH Latrine Options
An ecosan pilot project seems especially suitable in Payakumbuh, as this city has many low income peri-urban areas with kitchen gardens and agricultural fields. Women in the area said that they already use goat’s urine as fertilizer. Documents on eco-san and its economic benefits have been shared with the City Facilitator of Payakumbuh and the Private Sector Economist of ISSDP.
Community sanitation system: SANIMAS
A Sanimas is an on-site waste water and sewage collection and treatment system that can be shared by groups ranging from 5 to 10 families, such as a Dasa Wisma. It can collect black and grey water from a group of individually connected households such as a Posyandu or an MCK (see next section). The size of the groups sharing one SANIMAS may range from say 50 to 200 families.
The NGO BaliFokus has constructed 106 SANIMAS facilities in Indonesia. A visit to three systems for poor neighbourhoods established since 2003 (1/year) in Denpasar showed that in none of the served areas total coverage had been achieved. In the first 66% is connected, the second 83 - 87% and the third 84%. In the first people also use the CMK, but according to the operator only 10 households come every day. This would bring its coverage to 70%. Those not connected have private septic tanks, possibly unsafe, overhung toilets, or no toilets at all, especially immigrant labour in rented rooms. From a point of public health, 75% to 80% using safe sanitation is enough for better health, but from an individual perspective total safe coverage needs to be aimed for.
Case 10 – Field visit to SANIMAS
A visit to one of the Sanimas MCKs in Denpasar, Bali showed it to be well kept by the operator. There is a biogas tank under the centre. Users pay Rp. 500 for the toilets, Rp. 500, 1.000 or 2.000 for laundry (depending on the amount) and Rp. 500 for a shower. The income is Rp. 600.000/month. Running costs are Rp. 400,000. The remainder goes to BaliFokus for maintenance. It is more NGO than community-driven. The decorations, while beautiful (Fig. 1) were as far as could be established outsider-designed, and BaliFokus employs the operator and does the financial management. In contrast, the MCK visited in Solo is truly community-managed.
The investment cost is Rp. 311 million plus an (unknown) value of free community labour are too high to make them sustainable as a long term strategy for city sanitation. It would take the city of Denpasar between 20 and 30 years to serve all poor areas, under a condition of no population growth (see case 9). ISSDP has calculated that this amount is enough for 10-15 simple MCKs in poor areas.
Case 11 - Field visit to SANIMAS The case of Denpasar indicates that the investments are not sustainable for the cities. Using the Cash Aid Fuel Subsidy (BMM) as an indicator of poverty, the Fast Track Study showed that Denpasar has 3479 low-income households. In 2004, 0,3% of the city revenue or Rp. 234,030 million was allocated to sanitation (a campaign and one SANIMAS). At a unit cost of Rp. 2 million/household, one community of 117 households can be served with a SANIMAS each year. Including the contributions from the NGO and the community, SANIMAS I-III served an average of 187 households. Assuming that most BMM households live in SANIMAS areas, continuation of this allocation and speed means that a period of 3479/117= 30 years or at best 3479/187=19 years will be needed to serve the poor, at an unchanged growth of the poor population and at the same costs. The likelihood of urban growth, the annual cost increase and the depreciation of the existing SANIMAS systems will mean an even longer period to serve the poor at the current replication rate.
MCKs (Mandi, Cuci, Kakus ) are communal facilities with a number of toilets, and often (but not always) also a bathing and clothes washing facility, waste water drainage provisions and either an independent source of water such as a borehole or a connection to the city water supply, without or with a storage reservoir in case of intermittent service. MCKs can also be equipped with a Sanimas for the collection and treatment of sewage and (grey) waste water. In the six cities, both examples of poorly and well managed MCKs exist, the latter for example run by an NGO or by a group of user households.
Improved MCKs, that is with better participatory designs and management are a good solution for low income neighbourhoods where individual systems are not (yet) possible. The following are ways in which the cities and ISSDP can plan for more gender and poor sensitive MCKs:
Involve women and men heads of households (couples) including from poor households in the review and selection of sanitation options;
Facilitate that for implementation and management, a local committee is chosen consisting of both women and men by e.g. reflecting the different gender responsibilities, and that also poor households are represented;
Facilitate the participation of all committee members in choosing the design and location of the MCK in such a way that members of all households, including children, can use the facility;
Assist the committees to plan and implement (incl. monitor) equitable participation in construction;
Assist the committees to set up and implement an equitable management and financing system for the completed MCK. This can for example be roster based for husbands and wives as in the case in Solo, but may also involve hiring paid workers (preferably poor local women in need of a job);
Assist the committees to communicate with their constituencies during the planning process and account for service delivery and financial management to men and women household heads including from poor households.
Management and financing
MCKs may be run and managed by (1) male or female private entrepreneurs, either on a concession by the city or as a personal business (2) by a (female or male) caretaker hired, paid and supervised by the municipal authorities (less recommended as too distant) or by (3) the local administration (e.g. RT), a community committee or a women’s group, or (4) on a voluntary (e.g. roster) basis by women, or women and men. When men and women are both involved in caretaking, the women may do the work during the day and the men at night, so that the MCK can give a 24 hours. service. If MCKs are given out to an entrepreneur
Users usually pay per visit according to a tariff that differs for the type of use. There are however also communal facilities which are run on a flat or weighed monthly subscription basis for the whole family. Covering more than the day-to-day operation and maintenance costs and occasional smaller repairs is often difficult. For upgrading, expansion and/or replacement other sources of funding are usually required.
If the MCK is managed by a local functionary, group or committee, it is important that those concerned account for the service and the financial management, e.g. during a yearly community meeting. Other aspects to agree upon are the composition (including by sex and class, to represent different user categories in the community), the term of office, the functions of the respective committee members, including which positions are better held by a women and which by a men, and what qualifications are needed for the respective jobs, and the training/training requirements. For reasons to choose single women in the case of paid caretakers, see section 126.96.36.199 above.
MCK use and public health
The degree to which all men, women and children in a community can use the MCK whenever they need a toilet, a shower or laundry provisions depends on many factors: size and distance of the MCK, size of user population, presence and quality of open sanitation sites (e.g. near water), closed or open at night and the safety situation for women and girls, degree of queuing at peak hours etc. Because of these factors it is not easy to get 75-80% use from all user categories, which is the critical mass needed for an impact on public health (Esrey, 19…CHECK). This is something to check by the local leadership (male AND female!, as women deal with health) and Puskesmas staff, and then plan and take appropriate actions, e.g. adjust opening time, expand the MCK, demand a second MCK, develop social norms against open defecation, etc.
Decision Making. When an MCK is an option for basic sanitation services, it is important to discuss in depth its location, design and the pros and cons of the various operation, maintenance management and financing arrangements in a meeting or meetings with women and men. Special arrangements may be needed to ensure that women and men from poor households participate.
Solid Waste Management (SWM)
As seen from the SWM section in Chapter 4, there are excellent opportunities to include and expand community-based solid waste management in cooperation with the informal private sector (and for the city collection system also with the municipal system), in partnerships between communities and the informal private sector, between the municipal SWM sector and informal private sector, and between all three sectors (community, public and informal private sector).
In neighbourhoods and whole communities (e.g. RTs), inhabitants have various options for improving solid waste collection:
Type 1: households or women groups + informal private sector
Women segregate organic and non organic waste and recycle and reuse/sell the former (compost making) on site; Composting or vermi-composting is done by women of household, in small groups, or in the community. Informal private collectors (men) collect all other waste from the households and sort and sell recyclables to the secondary informal private sector.
Case 12 - Composting for income generation by women’s groups A women’s group in Koto Tangah, Payakumbuh, makes compost from kitchen and animal waste mixed with goat’s urine. They use it in their kitchen and flower gardens and sell potted ornamental plants and environmental plants (against dust, air pollution, etc.) , rent out plants to offices, and are starting on medicinal potted plants. The 26 members estimate that the average monthly income in cash and kind of Rp. 4.000,- per member constitutes 25% of the households’ average monthly income.
Type 2: households/ women groups + informal private sector + local management
Women segregate also other recyclable wastes at source; Informal private collectors - men and women - collect the different types of waste for processing/selling. Or the local youth group collects and sells the different wastes for income generation. Communities employs/pays male informal private collectors for door-to-door collection who bring the remaining waste to a TPS or the city dump. Alternatively, the collectors collect unseggregated waste and segregate it at a community-donated site, with the household tariff and revenue from the sale of the recycled waste covering the recurrent cost of the system.
Type 3: households (men, women, and children) + informal sector + city SWM
Women segregate also other recyclable wastes at source. Informal private collectors - men and women - collect the different types of waste for processing/selling. Women, men and/or children bring the remaining waste to the TPS, where the city collects it for final disposal. Or the city and informal sector collect home-segregated organic waste and the informal sector recycles this at a central place with the support of the city.
Based on the various partnership options and the already existing experiences in the community, local cadres can assist communities to inform them about options and choose, plan and test their own systems. Steps would be much the same as those for other options, except that it will now also involve contacting, and making arrangements with male and female workers in the own or neighbouring communities and possibly also at city level.
If composting by women/women’s groups is already practised, it may be possible to develop a strategy for horizontal learning. Under such a strategy, the cities assist women from the community or group concerned to visit women groups and meetings in other communities to inform them, and interested local male and female leaders, about composting, demonstrate the process and product, give hands-on training and invite participants to visit their community to observe the impacts.
Participation of poor community members
Special attention and measures may be needed to ensure that also poor women and men participate in learning and decision-making on participatory solid waste management.
Examples are extending information about and invitations to meeting to them, using extension methods suitable for non-literate participants and making sure poor women and men participate in training. The same goes for ensuring that the poor (women and men) are represented in decision-making bodies and sessions. Any step-by-step procedure developed for community or group SWM planning, implementation and management will need to be gender and poverty specific.
The development and implementation of civic-public-private-partnership strategies wit a gender and poverty focus in SWM also gives poor women and men in the informal private sector new opportunities to improve their livelihoods.
Environmental and health protection
An important part of the SWM city strategies is the protection of the housewives who sort and recycle waste at home, the employees of the city service and the men, women and children working in the informal sector against environmental and health risks associated with SWM. About 70% of the waste stream in the six cities is organic while much of the remainder are recyclable materials such as glass, plastic (in various forms), cardboard, paper and rubber. Decentralised composting can reduce the solid waste stream by 25-30% (Hawkins, 2007). Organic waste is generally safe, although it may contain faeces and chemicals from pesticides spraying, but there are associated risks with collection, recycling and end disposal which are important to check on and take actions against. Risks to check on are given in Table. 3 based on Cointreau (2006), while Table 3 contains the associated diseases. Prof. Dr. dr. Juli Sumirat, MPH has listed the health risks from poor drainage and solid waste management for ISSDP.
Table 3. Health risks from risky SWM practices and conditions
Occupational Health Risks
Environmental Health Risks
Type of risk
Types of People at risk
Type of risk
Types of People at risk
Back and joint injuries
Collectors (heavy lifts, heavy equipment) – mostly men
Ground- and surface water contamination from leakage of contaminants
All people using the water at site and downstream
Respiratory infections ingesting waste particles and fumes
Collectors, waste pickers at dumps – all sexes & ages
Methane and carbon dioxide air emissions from land disposals contributing to global warming, vector borne diseases and pathogen survival
omen, children and men living close to disposal areas (usually poor)
Infections from direct contacts with contaminated waste (e.g. faeces)
Handlers of organic waste women in households, waste collectors and recyclers – women & men
Animals feeding on organic solid waste and bringing animal and humans related diseases such as worms into the food chain
People eating infected animal meat.
Infections from animals (dog and rodent bites) or eating infected meat from animals feeding on waste
Waste pickers and people living around waste dumping sites
Solid waste clogging drains and retaining water, providing breeding sites for insect, rodent and bird vectors
Everyone living in such surroundings, but especially the most vulnerable (poor infants, pregnant mothers, sick people, elderly people)
Wounds leading to infections, tetanus, hepatitis and HIV
ecyclers of glass, Waste pickers at dumps, Handlers of hospital wastes, drug addicts
Headaches and nausea from high methane, carbon dioxide and carbon monoxide
Waste pickers and people living around waste dumping sites
Lead poisoning from batteries, paint and solders
Waste recyclers and pickers, both sexes and all ages
Traffic accidents, dump fires and slides
Waste collectors and pickers, both sexes and all ages
Hunt (2004) reports a high incidence of the following diseases: respiratory infections, acute bronchitis, skin infections, gastro-intestinal infections, helminth (worm) infections, mercury poisoning, tetanus, impaired pulmonary function, stunting and malnutrition, skeletal deformities, lymph node enlargement, HIV, lesions on hands and high infant mortality rates.
Table 4. Common infectious diseases among waste pickers, by type of transmission
Type of transmission of infections
Type of infectious diseases
Faecal – oral (from faeces in waste and wastewater)
Pneumonia, bronchitis, asthma, TB
Lack of water, soap and incentive* for hygiene
Skin and eye infections
* In waste picking families in India, women reported preparing meals immediately after returning home from waste picking, without washing. Most women pickers bathed only once a week. Since these women know they will become as dirty during the next day of work, they say they are not motivated to clean at the end of each day (Cointreau, 2006) . Especially vulnerable groups are child waste pickers and children, pregnant women and old people, living on or close to city dumps, usually poor and therefore extra vulnerable as they have even less resistance than their counterparts in other living areas. Good education and training, improved SWM conditions, operational procedures and equipment and protective clothing can do much to reduce the risk, while reducing the need for costly investments for transport and end-disposal and increasing employment opportunities for the lowest income groups.
Waste water disposal and drainage
Improving sanitation and solid waste disposal through gender- and poverty specific community participation and education programs has the additional advantage of contributing greatly to the reduction of waste water disposal and drainage problems.
Gender and poverty sensitive approaches further play a role in the direct participation of communities in WWD&D interventions during city drainage planning and implementation, by:
Participation of community men and male leaders (who deal with environmental cleaning) in the identification of locations where waste and drainage water does not run off due to a lack of sloping and/or blockages from solid waste;
Mapping of houses with and without soak pits as part of community mapping and action planning and implementation;
Participation of women in drain design and use and men on maintenance (e.g. Gotong Royong for cleaning), especially to avoid the use of drains for child faeces and solid waste disposal;
Avoiding that drains are constructed in the better parts of the city and drained water accumulates in the habitation areas of poor people.
Self help labour by men (digging) and women (catering) can reduce the construction costs.
Part of the planning is to agree on the value in cash to be contributed by those who do not contribute in labour and kind, usually the better off. Monitoring and public display of the status of individual household contributions helps in realising norms on contributions.